Provider Demographics
NPI:1770572455
Name:ODOM, KAREN LYNNE (PT, MOMT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNNE
Last Name:ODOM
Suffix:
Gender:F
Credentials:PT, MOMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40525
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-0525
Mailing Address - Country:US
Mailing Address - Phone:615-292-2209
Mailing Address - Fax:615-292-0357
Practice Address - Street 1:2300 21ST AVE S
Practice Address - Street 2:SUITE 303
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4968
Practice Address - Country:US
Practice Address - Phone:615-292-0199
Practice Address - Fax:615-292-0357
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000003363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3646097OtherPTAN
TN4126438OtherBCBS INDIVIDUAL